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Weekly Indemnity Claim |
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Use
You've become disabled (through injury or sickness) and are no longer able to work.
Use the Weekly
Indemnity Benefits Claim form to make your claim for Weekly
Indemnity benefits.
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Information Needed to Complete the Form
Your personal Member information is needed to complete the form.
In addition, information
such as:
- details of the sickness and/or accident,
- an authorized union signature,
- details of any other disability benefits to which you
are entitled, and
- the attending physician's statement and signature
is also required.
Please follow the instructions on the form. |
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Notes
- Your claim must be filed within 30
days of becoming disabled.
- Both your union and your doctor must complete their sections
of the form before the claim will be considered.
- The Member must sign on both
pages of the form.
Questions on completing the form should be directed to the Plan
Administrator.
Completed forms should be sent to the Plan
Administrator. |
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Plan Administrator
Ironworkers Local 97 Plan Administrator
c/o D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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